[Treatment] Restarting CPAP. Struggling with sleep

[talan]

Hi everyone,

It's a pleasure to meet you all!

I'm new to CPAP and here's my story:
Since back in 2013 I remember having a dry mouth during the nights. I woke up, drank some water and continued my sleep. I also felt tired with less energy throughout the day. This got worse over time and I visited many doctors to find out what I was suffering from. No one actually found anything of concern. No one connected it with a sleeping disorder. Two years ago, I also started to develop migraine with auras, especially bad during the mornings. I am currently on treatment for Migraine and it got better now.

Two months ago, just by coincidence, I changed my dentist (I relocated to Kuala Lumpur, Malaysia) and he happened to be trained in OSA. He advised me to do a sleep study at home, which I did. As you can imagine, it won't be a full-fledged sleep study but at this time I wasn't aware. The results indicated a bad sleep quality and elevated risk of sleep apnea. Based on the results, he advised me to go on a CPAP trial to see if things get better.

Today I'm in the 2nd week of my trial, and I can feel that I'm getting used to CPAP (Resmed Airsense 10). It took me 1 week to find the right mask (Resmed AirFit P10 works nicely now). The current issue that I'm facing is that especially in the 2nd half of the night I often wake up. It's either because of a leak or that the pressure gets too high. In the morning, I feel extremely tired and feel like I haven't slept at all.

So much for the background. After a lot of internet research (incl. finding this forum), I got to know that normally a full-fledged sleeping study is recommended. I found out that this is not that common in Malaysia, hence I guess the recommendation by my dentist. Nevertheless, I managed to find a sleep lab now and will have a full checkup done coming Friday.

As mentioned, I am currently trialing the Resmed Airsense 10 (haven't purchased it yet) and till I know more from my upcoming sleep study, I wanted to share with you my results. I'd like to see whether there's anything from your perspective that I could change/try to see if things get better?
In the chart, you'll see a break at 4:30. That's when I woke up and realized that the pressure was too strong. I turned the machine off and on to continue.
You can also see that I have a lot of CAs. I guess I will learn more from my sleep study, whether these are real or false alarms.
My current aim is to sleep through the night with the same amount or less apneas.

Please let me know if you have any ideas!
Many thanks and regards from KL,
Philip


   

[Gideon]

Welcome to the forum.
What is happening is Flow Limits are driving your pressure up.

To better manage your flow limits set your EPR = 2 fulltime.
Also set your max Pressure = 10.

These settings are tempered based on your Central apnea. Centrals may go up with the increase in EPR but if it does we need to know it.
The max pressure of 10 will clip your high values but you obstructive events are minimal.

Try these settings and re post and we will s| if yo need further adjustments

[SarcasticDave94]

It is asked you post OSCAR data to reflect setting changes, and the results of this. Also let us know how you feel. Tell us if any changes to how you or the therapy felt; these are important to helping you with adjustments.

Good luck and welcome to Apnea Board.

[Dormeo]

It's true that a polysomnographic study is preferable to a home sleep study, but did you get the actual report on the home study? If not, could you request it? Once you have a copy, you could post a scan here, first blanking out your personal information.

It's great you're using Oscar. Small thing: could you post a screenshot as an attachment? It might be easier to see. And all you need to include are those top six graphs (Events through Snores).

[talan]

Many thanks for all the responses!

@bonjour: your message just came right in time before I went to bed. I made the changes as suggested by you and below is the result. thank you!
@SarcasticDave94: Thanks and will definitely post how I feel
@Dormeo: I have it somewhere. Let me find it and I will attach it in a separate post. The screenshot should be an attachment. After a click on it, you should be able to zoom in. Using chrome. Is there another way to upload

Summary of last night:
Today is Sunday and I slept 1 hour longer than normal. Despite the extra hour, I still felt very tired and could have slept longer. I experienced brainfog and it took me a while (and 3 espresso shots) to get me going. Though I can only remember bits and pieces from the night (compared to the previous night, this night I didn't wake up), I could feel that the night was restless and that I was not fully asleep.

On the graphs there's one strange thing that I can't explain: there's a gap from 1:40-2:30. It seems that the machine was off as it shows no data and also no leak. However, I doubt that was the case as it means that I turned it back at 2:30. As I am taping my mouth, I must have taken the mask off as otherwise it would have been too hard to breathe. Or just a recording error? Let's see the next few nights how they go.

Other observations:
- AHI has increased. CAs are stable, however, all other apneas have increased. Do I need a higher max pressure?
- My flow limitations have not improved despite EPR=2, seem even slightly worse. I was expecting an improvement here.

If I was alone I would try with a higher min+max pressure, and EPR=3? 
Let me know what you think. 
Philip

   

[Gideon]

AHI levels are not static. I see normal day to day fluctuations,while up I don't look at these as increases.

You do NOT want a higher max. Your pressure will go up considerably due to flow limits. The Max is currently what is keeping your max in control.
If you want to try EPR=3 go ahead. I too did bot see the decrease in flow limits I hoped for but CA did not increase either so try that.

[talan]

Thanks, Fred.
I will try it the coming night!

If I set EPR=3, I should also increase the min by +1, am I correct? Basically a 9-10 min-max level.

Another question: Currently I am trialing the AirSense model. As it is a trial, I still have the flexibility to change to a bilevel model (e.g. the AirCurve VAuto). Wouldn't it make sense in my case? Any thoughts?

[talan]

One more addition in regards to the machine: Would it make sense to trial the ASV? Given the larger number of CAs? Just a thought as the provider won't let me trial forever, but there's a chance to make a change now.

[Gideon]

I would not change the min, just the EPR. Your theory is correct. IMHO some of your OA is Sleep Wake Junk (SWJ) so we will artificially lower the EPAP as a goal is to always use the lowest pressures that you are comfortable with. If needed we can make the adjustment tomorrow.

ASV Trial, Your CAI is fairly low and your 'numbers' don't merit it. It is an opportunity many would appreciate. At this point I'm not sure you would gain anything from it.

[talan]

Noted on the min pressure and the ASV. I will report back tomorrow.
How about an AirCurve instead of AirSense? Through my reading in this board, I learnt that it can run with EPR>3 whereas the AirSense has its max at 3.